Provider Demographics
NPI:1689327124
Name:LAWRENCE, DEJONA
Entity Type:Individual
Prefix:
First Name:DEJONA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 BROOKSBANK CV S
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-8553
Mailing Address - Country:US
Mailing Address - Phone:901-413-1177
Mailing Address - Fax:
Practice Address - Street 1:5054 BROOKSBANK CV S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-8553
Practice Address - Country:US
Practice Address - Phone:901-413-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker